Concussion guidelines becoming clearer

Can advanced protective gear actually produce more concussions? Some experts say helmets make players more aggressive. Here, the Colorado Avalanche's P.A. Parenteau (15) high-sticks the St. Louis Blues' David Backes (42) during a game in Denver on Sunday. AP PHOTO BY BARRY GUTIERREZ

Symptoms of a concussion

After a blow to the head, consider these as possible indicators:

Difficulty thinking clearly

Confusion or difficulty concentrating

Inability to remember something that happened right before, or after, the incident

Nausea, dizziness or vomiting

Sensitivity to light or noise

An athlete shouldn't resume practices or games until cleared by a team doctor or outside physician.

Note: The vast majority of concussions don't come with a loss of consciousness. If this happens, or if there are other, more serious symptoms like slurred speech or a headache that doesn't go away, seek immediate medical treatment.

SAN DIEGO – Although there's much still unknown about the causes and long-term effects of concussions, clear guidelines are emerging about the treatment of athletes who have suffered the injury.

For instance, anyone who has had a concussion in a game or practice – a type of injury caused by a fall or blow to the head, should not return to competition that same day.

"That, I think, everyone agrees upon. And you know what? Five years ago I think there was not consistency in that recommendation," said Dr. John DiFiori, chief of the Division of Sports Medicine at UCLA and team physician for the Bruins' football and men's basketball teams.

He's also the new president of the American Medical Society for Sports Medicine, which held its annual meeting in San Diego over the weekend. Concussions were the dominant issue at the conference; among a series of 16 research presentations on Saturday, 14 dealt with concussions or other neurological research.

One of them, by Dr. Daniel Herman of the University of Florida's Orthopaedics and Sports Medicine Institute, suggested that a concussion increases the risk of subsequent injuries in the legs and feet. This finding shows how the science on concussions is evolving.

A concussion is a type of brain injury often associated with the game of football but which can occur in just about any sport. Around 90 percent of professional and collegiate athletes recover within 10 days and can resume normal activities, DiFiori said. But there's strong evidence that children need more time off.

"It may be more like two weeks," DiFiori said.

Not only should kids sit out until they've been cleared by a doctor to play, they might need to take a break from studies, since reading or concentrating on a lesson could worsen symptoms.

"There's a gradual return to the classroom, just as there's a gradual return to the field of play," DiFiori said.

Coaches and players, and even the media, used to brush off a hard hit as "getting your bell rung," and players who put their health aside and went back in the game were praised for their toughness. Now there's much more caution. The cumulative effects of several concussions is still unclear, but a 2007 study showed that NFL players who'd had at least three concussions were three times as likely to be clinically depressed in their post-playing days.

"Back in the 1970s and '80s, people didn't do anything about it because we thought there was no harm in it. You get better, you go back, you're fine," said Dr. William P. Meehan III, director of the Concussion Clinic at Boston Children's Hospital. "Now people are more likely to report it to someone, a coach or athletic trainer or doctor, and get pulled out.

Enhanced awareness is leading to more diagnoses, Meehan said, but there really are more concussions occurring, and one reason could be the protective gear itself. Working in Boston, he treats just as many hockey-related concussions as football-related, but in both sports, the use of ever-more high-tech helmets might actually be counterproductive when it comes to reducing concussions.

"There were no helmets in ice hockey when I was a kid, then they became optional," he said. "Then somewhere, 1979 or 1980, they were made mandatory, but some players were grandfathered in. What happened is, when they introduced that extra equipment and made it mandatory, the rates of high-sticking penalties tripled. Nobody ever had their sticks way up in the air when a guy didn’t have a helmet, because you might hurt him. But once you think he’s protected, you play a little more carelessly and maybe a little more aggressively."

In its position statement on concussions, the AMSSM says: "Helmets, both hard (football, lacrosse and hockey) and soft (soccer, rugby) are best suited to prevent impact injuries (fracture, bleeding, laceration, etc.) but have not been shown to reduce the incidence and severity of concussions."

In soccer, some players have used soft headgear to cushion the impact of headers, but it hasn't caught on yet, and there's little push to make it mandatory. Which might be a good thing, DiFiori said.

"Players may be more aggressive heading the ball or going into other players because they’re not as fearful of getting hurt themselves," he said. "That’s really a counterproductive behavior that can occur with something that's well-intended. And there's no real good evidence that headgear in soccer can prevent injuries."

Can advanced protective gear actually produce more concussions? Some experts say helmets make players more aggressive. Here, the Colorado Avalanche's P.A. Parenteau (15) high-sticks the St. Louis Blues' David Backes (42) during a game in Denver on Sunday. AP PHOTO BY BARRY GUTIERREZ
Dr. John DiFiori, of UCLA, is the new president of the American Medical Society for Sports Medicine. AMSSM
Dr. William P. Meehan III, of Boston Children's Hospital, says players, parents and coaches are appropriately more concerned about complications related to concussions. AMSSM

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